Cost-effectiveness analysis of end-stage renal disease treatments.

The cost-effectiveness of various end-stage renal disease (ESRD) treatments was compared using two different cost measures. The first measure, gross social costs, excluded output gains due to treatment, whereas the second measure, net social costs, included output gains from both market and nonmarket activities. The cost-effectiveness criterion was the cost-per-life year gained or the implicit value of a year of life. The lower the cost-per-life year gained, the more cost-effective the treatment was. Four ERSD treatments were evaluated over 20 years. Home dialysis and transplantation were more cost-effective than in-center dialysis, regardless of whether gross or net social costs were used. However, lower values were obtained in the case of net social costs reflecting a provision for output gains due to treatment. The use of net social costs also resulted in greater variations in costs-per-life year gained by age. Changes in survival probabilities affected the results for transplant patients and dialysis patients differently.